European Journal of Cardio-Thoracic Surgery, Vol 4, 91-95, Copyright © 1990 by European Association for Cardio-thoracic Surgery
Relevance of anatomopathology of high oesophageal strictures to the design of surgical treatment
K Moghissi and P Goebells
Humberside Cardio-thoracic Surgical Centre, Castle Hill Hospital, Cottingham, Hull, UK.
From 1971-1987, inclusive, 407 patients with oesophageal stricture were
operated on by one surgeon. Of these, 116 were found to have high
oesophageal stricture and form the basis of this presentation. Every
patient had the usual clinical, radiological and endoscopic examinations
with biopsies taken above, at, and (when possible) below the stricture. At
operation, the surgical anatomy and pathology of the oesophagus and
mediastinum were determined and the site of the peritoneal reflexion and
its relation to the stricture were noted. In those resected, the resected
specimen was examined histopathologically. Thus clear aetiopathology could
be established and this was correlated with the type of operation.
Postoperatively, patients were followed up regularly. Results showed that
high strictures were of four definite types: (1) reflux strictures with
short oesophagus (n = 90) of whom 52% required resection and 48% had
conservative surgery, (2) caustic and other non-reflux strictures (n = 10)
all of whom required resection, (3) Barrett-type strictures (n = 8) all
treated by conservative surgery, (4) idiopathic strictures (n = 8) of whom
half required resection because of suspicion of malignancy. The study
indicated that the rational basis for the design of surgery is to ascertain
the aetiopathology which can only and finally be determined at operation.
